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Commentary published on 17 December 2010, see Pharmaceuticals 2010, 3(12), 3629-3632.

Open AccessReview
Pharmaceuticals 2010, 3(6), 1909-1935; doi:10.3390/ph3061909

Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications

Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, RCP 6233, Iowa City, IA 52242, USA
Received: 26 April 2010 / Revised: 11 May 2010 / Accepted: 9 June 2010 / Published: 11 June 2010
(This article belongs to the Special Issue Antiepileptic Drugs)
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Abstract

In the past twenty years, 14 new antiepileptic drugs have been approved for use in the United States and/or Europe. These drugs are eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, rufinamide, stiripentol, tiagabine, topiramate, vigabatrin and zonisamide. In general, the clinical utility of therapeutic drug monitoring has not been established in clinical trials for these new anticonvulsants, and clear guidelines for drug monitoring have yet to be defined. The antiepileptic drugs with the strongest justifications for drug monitoring are lamotrigine, oxcarbazepine, stiripentol, and zonisamide. Stiripentol and tiagabine are strongly protein bound and are candidates for free drug monitoring. Therapeutic drug monitoring has lower utility for gabapentin, pregabalin, and vigabatrin. Measurement of salivary drug concentrations has potential utility for therapeutic drug monitoring of lamotrigine, levetiracetam, and topiramate. Therapeutic drug monitoring of the new antiepileptic drugs will be discussed in managing patients with epilepsy.
Keywords: anticonvulsants; drug monitoring; drug toxicity; epilepsy; seizures anticonvulsants; drug monitoring; drug toxicity; epilepsy; seizures
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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Krasowski, M.D. Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications. Pharmaceuticals 2010, 3, 1909-1935.

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